Pain Assessment

5 Pain

Pain assessment

If pain is not relevant to your condition, please move on to the next form.

Throughout our lives, most of us have had pain from time to time (such as minor headaches, sprains and toothaches). Have you had pain other than these everyday kinds of pain today?
Please rate your pain at its worst in the last 24 hours
Please rate your pain at its least painful in the last 24 hours
Please rate your average pain the in the last 24 hours
Please rate your pain right now
In the last 24 hours, how much relief have pain treatments or medications provided?

In the past 24 hours, how much has your pain interfered with your:

General daily activity
Mood
Walking ability
Normal Work (work outside home and housework)
Relations with other people
Sleep
Enjoyment of life
Please describe all the types of pain you experience

Resilience Clinic

FREE
VIEW